| Doctor Name: | IDA E SUTHERLAND |
| NPI Number: | 1003925108 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 0024167940 |
| Business Practice Address: | 101 1st St Nw Pulaski, VA - 243015605 |
| Business Phone Number: | 5409800550 |
| Business Fax Number: | 5409805010 |
| Mailing Address: | 101 1st St Nw, PULASKI |
| State: | VA |
| Postal Code: | 243015605 |
| Phone Number: | 5409800550 |
| Fax Number: | 5409805010 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 09/20/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024167940 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |